D3 Nutrition Management for Patients Living with Chronic Conditions

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D3 Nutrition Management for Patients Living with
Chronic Conditions

• RECOMMENDATIONS FOR 2005

Katherine Brieger, RD,CDE Hudson River
HealthCare
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Goals And Priorities For Diabetes Nutrition

• Improving Glucose Control
• Improving Dyslipidemia
• Blood Pressure

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Goals And Priorities For Diabetes Nutrition

• Medical nutrition therapy can lower levels
• of glycosylated hemoglobin (HbA1c)
• by 1-2.

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Goals And Priorities For Diabetes Nutrition

• Reducing saturated fat to 7 to 10 of daily
• energy intake and dietary cholesterol to
• 200-300 mg/day lowers low-density
• lipoprotein (LDL) cholesterol levels by 12
• to 16 (19-25 mg/dl)

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Goals And Priorities For Diabetes Nutrition

• Reducing sodium intake to approximately
• 2,400 mg/day is associated with a decline in
• systolic blood pressure of 6 mm Hg and in
• diastolic blood pressure of 2 mm Hg.

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Goals And Priorities For Diabetes Nutrition

• Type 2 diabetes should adopt lifestyle
• strategies that improve the associated
• metabolic abnormalities of glycemia,
• dyslipidemia, and hypertension
• Weight Loss
• Lowering consumption of saturated fats,
• monitoring carbohydrate intake, and
• increasing physical activity

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Intake of Macronutrients

• Carbohydrate
• Total amount of carbohydrate in meals and
• snacks is more important than the source

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Intake of Macronutrients

• Glycemic response is identical as long as the
• total amount of carbohydrate is kept constant.

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Intake of Macronutrients

• Using preprandial and postprandial glucose
• data, individuals can determine whether
• certain foods cause their glycemic response to
• be exaggerated.

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Intake of Macronutrients

• Fiber
• 25 g/day

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Intake of Macronutrients

• Protein 15 to 20 of energy intake
• Evidence that lowering protein intake to
• 0.8-1.0 g/kg/day for patients with overt
• nephropathy may slow the progress of
• renal disease.

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Intake of Macronutrients

• Protein
• Avoid intake greater than 20 of energy
• May result in microalbuminuria

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Intake of Macronutrients

• Protein does not slow the absorption of
• fast acting carbohydrates and adding protein
• to the treatment of hypoglycemia does not
• prevent subsequent hypoglycemia.

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Intake of Macronutrients

• Long term effects of high protein, low
• carbohydrate diet are unknown. Although
• initially blood glucose levels may improve
• and weight may be lost, it is unknown
• whether long term weight loss is maintained
• better with these diets than with other low
• calorie diets.

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Intake of Macronutrients

• Fat
• Lower intake of saturated fatty acids, trans
• fatty acids, and dietary cholesterol is
• recommended, especially for individuals with
• LDL cholesterol of 100 mg/dl or higher. To
• lower LDL cholesterol, patients can reduce
• calories from saturated fat

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Carbohydrate

• Foods containing carbohydrate from whole
• grains, fruits, vegetables, and low-fat milk are
• important and should be included in a
• healthful diet.

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Carbohydrate

• Sucrose and sucrose-containing foods do not
• need to be restricted by people with diabetes.
• Such foods should be substituted for other
• carbohydrate sources

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Carbohydrate

• Non-nutritive sweeteners are safe when
• consumed within established FDA guidelines.

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Protein

• In individuals with controlled Type 2
• diabetes, ingested protein does not increase
• plasma glucose concentrations, although
• ingested protein is just as potent a stimulant of
• insulin secretion as carbohydrate.

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Dietary Fat

• Less than 10 of energy intake should be
• derived from saturated fats. Some individuals
• may benefit from lowering saturated fat intake
• to less than 7 of energy intake.

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Dietary Fat

• Dietary cholesterol intake should be less than
• 300 mg/day. Some individuals may benefit
• from lowering dietary cholesterol to less than
• 200 mg/day.

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Energy Balance and Obesity

• In insulin-resistant individuals, reduced
• energy intake and modest weight loss
• improve insulin resistance and glycemia in the
• short term.

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Energy Balance and Obesity

• Structured programs that provide education
• and emphasize lifestyle changes, including
• reduced fat and energy intake, regular
• physical activity, and regular participant
• contact, can produce long-term weight loss on
• the order of 5 to 7 of starting weight.

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Goals And Priorities For Diabetes Nutrition

• Insulin Therapy
• Determine a meal plan
• Integrate an insulin regimen
• Usual eating habits and schedules

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Prevention of Diabetes

• Structured programs that provide education
• and emphasize lifestyle changes, including
• reduced fat and energy intake, regular
• physical activity, and regular participant
• contact, can produce long-term weight loss of
• 5 to 7 of starting weight and reduce the
• risk of developing diabetes.

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Prevention of Diabetes

• All individuals, especially family members of
• persons with Type 2 diabetes, should be
• encouraged to engage in regular physical
• activity to decrease the risk of developing
• Type 2 diabetes.

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Other Dietary Components

• Micronutrients
• No evidence of benefit from vitamin or
• mineral supplementation in persons with
• diabetes who do not have underlying
• deficiencies. Exceptions are folate for
• preventing birth defects and calcium for
• preventing bone disease.

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Other Dietary Components

• Alcohol
• Limit daily intake to one drink for women and
• two drinks for men.
• For individuals susceptible to hypoglycemia,
• alcohol should be consumed with food.

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CVD Nutrition Intervention